Prescription Pain Medications and Your Gut: The Hidden Health Risks You Need to Know

by Dr. Alicia McComas, ND

Prescription pain medications, known as opioids, are commonly used to manage moderate to severe pain. These medications contain compounds that bind to opioid receptors in the brain and other parts of the body, effectively blocking pain signals. However, while they can provide significant relief, opioids can also lead to digestive health issues such as Gastroesophageal Reflux Disease (GERD) and diverticulosis.

How Opioids Affect the Digestive System

Opioids impact the digestive tract in several ways:

• Slowed Gut Motility: Opioids slow down the movement of food through the digestive system, leading to constipation.  This occurs because opioids bind to receptors in the gastrointestinal tract, reducing peristalsis—the wave-like muscle contractions that propel food forward.

• Weakened Lower Esophageal Sphincter (LES): The LES is a muscle that prevents stomach acid from flowing back into the esophagus.  Opioids can relax this muscle, increasing the risk of acid reflux and contributing to GERD symptoms.

Linking Opioid Use to GERD and Diverticulosis

• GERD: The relaxation of the LES combined with delayed stomach emptying due to opioids can cause stomach contents, including acid, to back up into the esophagus, leading to heartburn and other GERD symptoms.

• Diverticulosis: Chronic constipation increases pressure within the colon, which can cause small pouches, known as diverticula, to form in the colon walls—a condition called diverticulosis.  If these pouches become inflamed or infected, it leads to diverticulitis, a more serious condition.

Managing Digestive Health While on Opioid Therapy

If you're prescribed opioids and are concerned about digestive health, consider the following strategies:

1. Dietary Adjustments:

   • Increase Fiber Intake Gradually: Incorporate fiber-rich foods like fruits, vegetables, and whole grains to promote regular bowel movements.  Increase fiber intake slowly to prevent bloating and gas.

   • Stay Hydrated: Adequate water intake helps soften stools and supports digestive health.

   • Eat Smaller, Frequent Meals: This can reduce the likelihood of acid reflux by decreasing stomach pressure.

   • Avoid Trigger Foods: Limit foods and beverages that can exacerbate GERD symptoms, such as spicy foods, caffeine, alcohol, and fatty meals.

2. Lifestyle Modifications:

   • Regular Physical Activity: Engaging in regular exercise can enhance gut motility and alleviate constipation.

   • Elevate the Head During Sleep: Raising the head of your bed can help prevent nighttime acid reflux.

   • Avoid Lying Down After Eating: Wait at least two to three hours after eating before lying down to reduce the risk of reflux.

Takeaway

While opioids are effective for pain management, they can adversely affect digestive health, potentially leading to conditions like GERD and diverticulosis. By adopting dietary and lifestyle changes and maintaining open communication with your healthcare provider, you can mitigate these risks and support your digestive well-being during opioid therapy.

If you or someone you know is struggling with opioid use or addiction, it's important to seek help. Contact the SAMHSA National Helpline at 1-800-662-HELP (4357) for confidential assistance. 

Resources:

Centers for Disease Control and Prevention. (2021). Prescription opioids: What you need to know. Retrieved from https://www.cdc.gov/opioids/basics/prescribed.html

Farmer, A. D., Holt, C. B., Downes, T. J., Dewit, O., & Aziz, Q. (2020). Pathophysiology, diagnosis, and management of opioid-induced constipation. The Lancet Gastroenterology & Hepatology, 5(5), 425-436. https://doi.org/10.1016/S2468-1253(19)30410-1

Rao, S. S. C., & Singh, S. (2020). Clinical utility of opioid antagonists in chronic constipation: A review of current evidence. Therapeutic Advances in Gastroenterology, 13, 175628482095411. https://doi.org/10.1177/1756284820954116

Schroeder, A. D., & Basson, M. D. (2021). Diverticular disease and GERD: A review of pathophysiology and management considerations. World Journal of Gastroenterology, 27(3), 198-215. https://doi.org/10.3748/wjg.v27.i3.198

Substance Abuse and Mental Health Services Administration. (2023). SAMHSA’s National Helpline. Retrieved from https://www.samhsa.gov/find-help/helplines/national-helpline

Thummler, K., Ferreira, M., & Dumitraşcu, D. L. (2020). The role of opioids and the gut-brain axis in gastrointestinal symptoms. Journal of Clinical Medicine, 9(10), 3258. https://doi.org/10.3390/jcm9103258